Comparative features of different forms of ovarian apoplexy

Abstract

DOI: 10.52705/2788-6190-2023-02-9
УДК 618.11-007.251-005.1

The objective: to learn comparative aspects for women with the different forms of apoplexy onthe modern stage.

Materials and methods. It was conducted clinical-and-laboratory inspection 140 women fromwhich – 65 patients by the anaemic form of ovarian apoplexy, that first added to the laparoscopicoperations. These patients were plugged in prospective research and part on two groupsdepending on the method to hemostasis used during an operation. A to 1 group entered 35patients, hemostasis which carried out by bipolar coagulation, in 2 groups – 30 patients, bleedingfrom an ovary in which was shut-down by imposition of guy-sutures. Repeatedly operated womenwere included in the 3rd and 4th groups – 21 and 19 women, respectively.In that or other group patients were taken away by a «blind» method. In research patients joined withthe stable indexes of hemodynamics before interference and duration of hospitalization not more than24 hours. All operations were executed by a the same surgical brigade. The criteria of exception fromresearch were intra-abdominal bleeding as a result of break of benign tumour or endometrioid ovariancyst; a presence in anamnesis of operative interferences is on ovaries; and also reception of the combinedoral contraceptives or use of methods of stimulation of superovulation exogenous gonadotropins lessthan 3 months prior to an operation. The group of comparison was made 35 patients from laparoscopicby the confirmed pain form of ovarian apoplexy, that got conservative treatment.

Results. Working the it is possible to say out total of analysis of results of preoperative inspection,that more than any procatarxiss of ovarian apoplexy absented in the halves of patients. Theinvestigated groups did not differ on character of clinical displays of anaemic form of ovarianapoplexy, frequency of anaemia, ultrasonic indexes of volumes of the staggered ovary and freefluidity in the cavity of pelvis, to the parameters of preoperative preparation.The group of comparison differed from the investigated groups only the considerably less volumeof free fluidity in the cavity of pelvis, discovered at an echography and structure of certificates tothe leadthrough of diagnostic laparoscopy. After confirmation of diagnosis of anaemic form ofovarian apoplexy to all patients operative treatment was carried out. In majority 28 (80%) patientsof group of comparison after confirmation of diagnosis pain form of ovarian apoplexy and indefault of in the abdominal region of far of serofluid of no subsequent surgical manipulations didnot execute. To 7 (20%) patients of this group with the volume of serosal exsudate more than200 ml his evacuation and washing to the cavity of pelvis was executed solution.All operations were executed fully by laparoscopic access, there was not a single passing to laparotomy.Intraoperative complications were not. The catchment of abdominal region was carried out only 2 (3,1%)by a patient. In 13 (37,1%) patients of a 1 group and 11 (36,7%) operations of stop of bleeding froman ovary were combined with other interferences (р>0,05). The most frequent united operation was adivision of joints in the cavity of small pelvis, which was executed 8 (23%) by the patient of a 1 group and6 (20%) by a patient 2 groups (р>0,05). 3 (8,6%) by the patient of a 1 group and 4 (13,3%) by a patient2 groups the executed coagulation of hearths of endometriosis (р>0,05). Two by the patient of a 1 groupthe delete of shallow (to 2 see is in a diameter) subserosal myomatous node was executed on a leg.

Conclusion. The results of the conducted researches testify that the unique meaningful differencebetween two investigated groups was an index of duration of operative interference (р<0,05). 1,5time had operations almost more protracted in 2 groups of patients, hemostasis which carried outby imposition of guy-sutures on an ovary.At the analysis of digital records of operative manual defined that reason of increase of his duration isthe stage to hemostasis which foresaw at a 100% husking of the cysts and impositions of one or a fewguy-sutures on the wound of ovary. Duration of the stage grew, as a result of that laparoscopic impositionof guy-sutures, especially with the intracorporal stringing of nodes, is labour intensive enough procedure.No meaningful differences between groups in the middle volume of blood loss, frequency of theunited operations, postoperative conduct, motion of postoperative period and duration of stay inpermanent establishment discovered it was not.